Nurse practitioner vs. physician assistant: Scope and education

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Understand the similarities and differences in training to determine the best fit for your practice.

Overview of NP and PA education and assessment

Nurse practitioners (NPs) and physician assistants (PAs) are both non-physician clinicians (NPCs) who can diagnose and treat patients. Education and training requirements are standardized, with established competencies for licensing and/or board certification. Privileging allows NPCs to practice to their desired scope based on state regulations, their license and credentials.

However, previous clinical experience can vary greatly among NPCs. Before adding one to your team, it's important to carefully evaluate each candidate’s education, training and hands-on experience. Including shadowing time as part of the interview process can help gauge an NPC’s expertise and comfort with your patient population and identify onboarding and orientation needs.

Beyond the state regulations noted above, health systems and employers may have guidelines, policies or procedures related to how NPCs can practice.

NP vs. PA training comparison chart

Comparison area

 Nurse practictioners Physician assistants
Basics

  • Licensed clinicians who are trained in the advanced practice of nursing with a chosen population focus

  • May practice independently in more than 30 states

  • Licensed clinicians who can practice medicine in every specialty and setting

  • Nearly always work under supervision or in collaboration with a physician

Education

  • Master’s or doctoral degree

  • Virtual programs available 

  • Trained in advanced practice of nursing 

  • Must be a registered nurse with a nursing license

  • At least 500 clinical hours

  • Trained in chosen population focus area: family, adult/ gerontology, neonatal, pediatrics, women’s health or psychiatric/mental health

  • Master’s degree 

  • In-person education

  • Curriculum modeled on medical school curriculum 

  • 2,000 hours of clinical rotations in family medicine, internal medicine, general surgery, pediatrics, obstetrics and gynecology, emergency medicine and psychiatry 

  • Trained as a medical generalist 

  • Increasing number of residency opportunities available for specialization

Regulations

  • Regulated by state nursing boards 

  • In a handful of states, the medical board has some role in regulation.

  • Regulated by state medical board (or separate PA board if the state has one) 

Certification maintenance

  • 100 hours of continuing education and 1,000 clinical hours every five years 

  • May take an exam as an alternative to 1,000 hours of clinical practice every five years 

  • Six certifying bodies (one for each population focus area)

  • 100 hours of CME every two years 

  • Recertification every 10 years through an exam that evaluates general medical knowledge 

  • One certifying body

Training and experience interview questions

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Asking the right questions can help you understand each NPC’s education, training and experience. This allows you to assess how an NPC will best fit into your practice and determine how to structure your onboarding and training plans.

When interviewing an NP or PA, ask:

  • Are you board-certified and licensed to practice in this state?

  • What privileges have you obtained from former employers?

  • What can you tell us about your family medicine clinical rotations and care experiences?

  • What patient ages are you comfortable seeing?

  • Are you comfortable with medically complex patients?

  • (For NPs) Are you specifically trained in family medicine?

  • What level of experience do you have with common procedures in our practice area?

26%

U.S. health care visits delivered by non-physicians such as NPs or PAs

Source: Harvard Medical School

Resources on NPC scope and education

From the American Academy of PAs

From the National Organization of Nurse Practitioner Faculties

From the American Association of Nurse Practitioners

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